|Part D Benefit:||Yes|
|Rx Gap Coverage:||N|
HumanaChoice H5216-043 is a Preferred Provider Organization Medicare Advantage Plan, by Humana, available in Taylor County, TX. It gives you freedom to choose your doctors, specialists and hospital facilities. Plus, you can keep your out of pocket costs as low as possible when you use the Humana network. You get predictable copayments and coinsurance, making it easier to keep your healthcare costs in check.
The monthly premium for this plan in Taylor County, TX is $15.00. This amount is paid directly to Humana.
If you enroll in this plan you will pay your Medicare Part B premium plus this plan's monthly premium. Most people pay the standard Part B premium, but some beneficiaries pay higher Part B premiums due to their annual income (over $85k for singles or $170k for married couples). Late enrollment penalties can also increase your Part B premium.
Your monthly premium is independent of the healthcare services you use. When you see your doctor, or if you are admitted into the hospital for treatment, you have copayments. Your prescriptions also have copayments.
Maximum Out-of-Pocket Limit
There is a maximum out of pocket limit of $6,700 on your healthcare costs in 2018. This is commonly called the plan MOOP. The MOOP does not include your prescriptions or your monthly premium.
Although the mandatory MOOP limit is $6,700, Medicare allows for a lower “Voluntary MOOP” that can be as low as $3,400. This plan's MOOP is $6,700. Take this figure into as much consideration along with the premium and the copay.
If you are comparing this plan with Original Medicare, factor in that there are no out-of-pocket limits on Medicare Parts A and B. With Original Medicare you'll need a Medicare Supplement to cover what the government doesn't.
Coverage, Copayments & Coinsurance
The HumanaChoice H5216-043 plan offers the same basic benefits as Original Medicare. The big difference is copayments and coinsurances. Below you will find (where available) what you will pay for common health care services.
Most plans have copayments when you see your primary care doctor or a specialist. Here's how this plan works:
|Primary Care Doctor:||$5 co-payment|
|Physician Specialist:||$35 co-payment|
|Occupational Therapist:||$25 co-payment|
|Physical Therapist:||$30 co-payment|
|Speech Terapist:||$30 co-payment|
If you are admitted to a hospital or clinic for treatment and stay overnight, you are an inpatient. Most plans have tiered costs for inpatient treatment. Here's how this plan covers you:
- Day 1 to 5: $325
- Day 6 to 90: $0
The following preventative healthcare services are covered at no cost:
- Abdominal aortic aneurysm screening
- Alcohol misuse counseling
- Bone mass measurement
- Breast cancer screening (mammogram)
- Cardiovascular disease (behavioral therapy)
- Cardiovascular screenings
- Cervical and vaginal cancer screening
- Colorectal cancer screenings
- Depression screening
- Diabetes screenings
- HIV screening
- Medical nutrition therapy services
- Obesity screening and counseling
- Prostate cancer screenings (PSA)
- Sexually transmitted infections screening and counseling
- Tobacco use cessation counseling
- Vaccines including Flu shots Hepatitis B shots Pneumococcal shots
- Welcome to Medicare preventive visit
- Yearly Wellness visit
Prescription Drug Coverage
This plan includes Medicare Part D coverage for your prescription medications. The table below outlines what you will pay (the copayment) at your pharmacy for medications at each tier level.
If you are entitled to Part D assistance, your premium will be adjusted based on your percentage.
The Part D deductible on plan is $360.00. This is the amount you will pay until the plan begins to pay its portion.
Medicare Plan Rating
Medicare gave the HumanaChoice H5216-043 plan an average rating of -1.0 out of 5 stars. This rating is , by Medicare's definition.
Medicare rates the quality of all Medicare Advantage plans. Ratings help shopper considering enrollment. Five stars represents the best quality. Plans rated less than 2.5 stars cannot be sold.
Compare HumanaChoice H5216-043 with these top rated plans available in Taylor County:
- HumanaChoice H5216-128
- Humana Gold Choice H8145-084
- Humana Gold Choice H8145-126
- HumanaChoice R4182-001
- HumanaChoice R4182-003
HumanaChoice H5216-043 Availability
HumanaChoice H5216-043 is available in Lawn, Tuscola, Ovalo, Buffalo Gap, Tye, Abilene, Trent, Merkel, Dyess AFB, and all other areas of Taylor County.
This page was last updated on 10/14/2017.
Plan data on Medicare-Plans.net comes from CMS.gov and is subject to change. The Centers for Medicare and Medicaid Services has neither reviewed nor endorsed the information on this site.
This page is a brief summary, not a complete description. Limitations, co-payments, and restrictions may apply. For more information contact the plan directly.
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